Phimosis: what it is, causes, symptoms and treatments

Phimosis is an abnormality of the skin covering the penis. This condition occurs when the foreskin is too narrow in the area of the glans penis, so it cannot be fully or partially retracted.

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Phimosis is usually a very common problem in boys, especially in young children. However, in most cases, the condition corrects itself as the child grows older, most commonly by the age of 3 years. Even so, it is not a condition that only affects infants; it can also develop in young and older adults.

To give you a better understanding of this condition, this article provides more detailed information on the types of phimosis, its symptoms and treatments.

A distinction can be made between two types of phimosis:

Physiological or congenital phimosis

Physiological phimosis is present from birth and is caused by adhesion between the epithelial layers of the inner foreskin and the glans penis. This type of phimosis usually disappears with time, as the skin becomes more elastic and widens until the glans can be completely uncovered.

If this anomaly does not disappear after the age of 10, it is advisable to see a urological specialist and begin the most appropriate treatment.

Pathological or acquired phimosis

Unlike congenital phimosis, this type of condition can occur at any age. It usually develops due to other problems such as balanitis, a malignant tumour, poor hygiene of the area, forced retraction, injury or frequent infections of the penis.

It is very important that you see a specialist as soon as possible if you find yourself in any of the above situations, in order to avoid more serious complications.

Another way of classifying the types of phimosis is as follows:

• Punctiform phimosis: the opening of the foreskin is very small in diameter, almost imperceptible, although the appearance and thickness of the skin is completely normal.
• Cicatricial or annular non-retractable phimosis: this type of phimosis is characterised by hardening of the skin around the opening of the foreskin as a result of infection or inflammation in the area.
• Annular phimosis: this type of phimosis occurs when the foreskin has different levels of thickness or diameter, preventing the skin from retracting.

Another factor that you should know about phimosis is the different degrees that this anomaly can present depending on its severity. If you read on, you will find a detailed description of the differences between the five degrees of phimosis that exist.

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Degrees of phimosis

Depending on the degree of tightness of the foreskin, the following degrees of phimosis can be distinguished:

• Grade 1: punctiform, the glans penis is not visible, as the foreskin cannot be retracted at all, it is completely closed.
• Grade 2: punctiform, only the urinary meatus is visible, as the foreskin can be minimally retracted.
• Grade 3: the foreskin can be retracted to the middle of the glans penis.
• Grade 4: the foreskin can be retracted only halfway to the glans penis.
• Grade 5: the foreskin may retract completely, but causes pain and a phimotic ring is observed.

Just as there are various types of phimosis, there are also different components that influence its appearance, among the possible causes we highlight the following:

• Congenital phimosis: as we mentioned at the beginning of this article, most baby boys have phimosis. This disappears between 3 and 5 years of age on its own through the natural growth of the child. If it persists, the cause of phimosis in boys is usually due to forced retraction of the foreskin during hygiene.
• Frequent infections: infections are usually caused by fungal infections, which cause chronic inflammation with scarring of the foreskin, leading to narrowing of the foreskin.
• Tears or poorly healed wounds: as in the previous case, after a tear or wound, scarring of the tissue causes hardening of the foreskin, making it difficult for the skin to retract.
• Inflammation of the foreskin or glans penis: as a result of pathologies such as Balanitis, the skin of the foreskin becomes inflamed and, if not treated in time, can completely cover the glans penis, preventing the removal of the preputial skin. Similarly, this can lead to thickening of the tissue causing fibrosis, which further complicates the situation and the symptoms of phimosis.

Although it is possible to have no symptoms when you suffer from phimosis, over time they tend to appear and limit your day-to-day life. That is why the best thing to do is to look out for any of the following signs and see a specialist as soon as possible to remedy it.

• Difficulty retracting the foreskin: you may find it difficult to retract the foreskin completely during intercourse, masturbation or cleaning the area. This limitation causes pain and discomfort.
• A feeling of tightness: as a result of the previous symptom, you may feel a feeling of tightness caused by the difficulty in retracting the foreskin. In addition, this symptom is often compounded by the fact that the frenulum is too short, which means that the tension on the glans is very uncomfortable.
• Inflammation of the foreskin when urinating: as a result of phimosis, the foreskin may become inflamed when urinating, causing itching and stinging.
• Changes in urinary stream: because of the pressure on the glans penis due to phimosis, your urinary stream may be too thin and divert during urination, and you may have difficulty urinating.
• Inflammation or infection of the glans and foreskin: normally, due to poor hygiene of the area as a result of the difficulty in retracting the foreskin, it is common for the glans and foreskin to become inflamed and even suffer from an associated infection or pathology.
• Appearance of whitish remains: it is very common for whitish remains to appear in the area, a symptom that in turn is a consequence of the lack of hygiene mentioned above.

The diagnosis of phimosis can be made with a first check-up and confirmed when the specialist cannot retract the foreskin normally. Even so, below we explain how a specific diagnosis can be made in both children and adults.

Diagnosis in children

In the case of boys, phimosis can usually be determined with the naked eye during hygiene, so don't worry, as this anomaly is very common at an early age.

It is possible that there may be itching or irritation in the area due to the accumulation of urine in the phimotic hood. Other signs of phimosis are unexplained urinary tract infections or skin infections in the genital area, so don't hesitate to see a doctor and treat the problem as soon as possible.

During the consultation with the specialist, he or she will carry out a thorough abdominal and genital examination of the child and will inform you of the definitive diagnosis.

Diagnosis in adults

Please note that as a general rule, all phimosis in adults is considered pathological.

To diagnose you, the doctor will ask if you have painful erections, lesions or sores on the skin of your penis. You should also tell the doctor if you have difficulty urinating or problems having sexual intercourse. He or she will also examine the area to determine the most effective treatment.

Phimosis surgery in children

You should consider surgery as a last resort to solve phimosis in the case of boys. It is not recommended to operate on a boy until he is 5-7 years old, although you can wait a few more years if they have no symptoms, as the abnormality may resolve on its own.

It is advisable to wait until the child is 8 years old to avoid complications and the dangers of anaesthesia. Even so, it is advisable to resort to surgery if the child has swelling of the foreskin, difficulty in uncovering the glans, a history of balanitis, frequent urinary tract infections or paraphimosis.

Phimosis surgery in adults

As you may already know, phimosis surgery is fully indicated for adult males, especially in moderate and severe cases. With surgery, you can be sure to remedy any problems you may have during sexual activities and secondary complications such as infections or inflammation of the foreskin.

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Treatment with corticosteroid ointment

Before resorting to surgical treatment, it is possible to solve the problem with pharmacological treatment. This treatment consists of administering corticosteroid cream which is applied to the junction between the foreskin and the glans penis, while gently and gradually retracting the foreskin. This procedure weakens the tissues and makes the foreskin more elastic.

This treatment is usually effective mainly in children and sometimes in mild cases of phimosis in adults. In addition, you should know that this procedure cannot be prolonged over a long period of time, as it loses its effectiveness and can produce side effects, so the most important thing is to follow the guidelines and indications set by your specialist.

Treatment of phimosis by surgery: circumcision

If the phimosis does not resolve with the above procedure, the definitive treatment is surgery. In the case of boys, it is advisable to wait at least until they reach four years of age. For adults, surgery is indicated at any age, as long as there are no symptoms or health problems that would discourage it.

Circumcision consists of removing the part of the foreskin that prevents the glans from being revealed, i.e. the skin covering the tip of the penis is removed. It is a simple operation performed by a urologist. This procedure is characterised by the fact that it requires only a few days of rest and does not usually present complications.

In addition to rapid healing, this surgical procedure has other important benefits such as reduced risk of urinary tract infections, reduced chances of penile cancer and sexually transmitted diseases.

If you have phimosis and are thinking of having surgery with us, you can request an immediate and free surgical assessment consultation with our urology specialist by clicking below:

Do you need phimosis surgery?

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